title: Echocardiography in the invasive laboratory: utility of two-dimensional echocardiography in performing transseptal catheterization.
abstract: OBJECTIVE
  To evaluate the potential utility of transthoracic two-dimensional echocardiography as an aid in the technique of transseptal catheterization.
  
  
  METHODS
  We performed a prospective study of 58 patients (29 men and 29 women; mean age, 64.2 years) referred for cardiac catheterization, in whom a systematic approach was used with selective application of two-dimensional echocardiography.
  
  
  METHODS
  The study group of 58 patients had the following diagnoses: mitral stenosis in 17, hypertrophic cardiomyopathy in 13, dilated cardiomyopathy in 13, aortic stenosis in 13, and prosthetic valve dysfunction and pulmonary hypertension in 1 each. With use of only fluoroscopic guidance, initial gentle pressure on the dilator alone was attempted for left atrial access. If the catheter resisted entry into the left atrium, two-dimensional echocardiography was performed to assess the catheter's position relative to the atrial septum, and adjustments were made accordingly. Transseptal puncture with a Brockenbrough needle was performed only after confirmation of the catheter position at the region of the fossa ovalis with two-dimensional echocardiography.
  
  
  RESULTS
  The catheterization procedure was performed without complication in all 58 patients; the mean time to catheter placement was 5.6 +/- 3.5 minutes (range, 3 to 20). Two-dimensional echocardiography was used in 33 patients (57%) when left atrial access was not obtained. On the basis of echocardiographic images, the transseptal catheter had to be repositioned in 16 of these 33 patients (48%).
  
  
  CONCLUSIONS
  Two-dimensional echocardiography offers value in demonstrating catheter position during transseptal catheterization and may be used in some patients to ensure transseptal puncture at the region of the fossa ovalis.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Hurrell
authors.forename: R A
authors.initials: RA
authors.lastname: Nishimura
authors.forename: J D
authors.initials: JD
authors.lastname: Symanski
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography / Q000379:methods; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis; D006346:Heart Septum; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies